Leveling and Zeroing :

Phlebostatic Axis :

Troubleshooting :

11 Troubleshooting Dampened waveform
No waveform
Overshooting

Troubleshooting… :

12 Troubleshooting… Damp tracings / inaccurate readings
Is the monitor in the proper mode and scale settings?
Is the transducer level with the phlebostatic axis ?
Are all the connection tight and all the stopcocks pointing in the correct direction?
Is there blood in the line?
Are there air bubbles in the system that may cause wave form distortions
Are there occlusions or kinking in the line

Slide 14:

Complications :

II. PREVENTION OF INFECTION :

16 II. PREVENTION OF INFECTION Use aseptic technique during insertion
Remove Catheter as soon as possible
Use non-vented caps on all stopcocks
Change line components per policies
Minimize system entry
-use closed blood sampling system
-use continuous cardiac output system

III. PREVENTION OF THROMBOSIS :

17 III. PREVENTION OF THROMBOSIS Use continuous flush device
Remove Catheter as soon as possible
Use of heparin in flush solution,
-supportive data unclear
-contraindicated with any coagulopathy
Use of catheters with heparin coating

Slide 27:

27 CVP PAP

Introduction :

28 Introduction Venous pressure is a term that represents the average blood pressure within the venous compartment.
The term "central venous pressure" (CVP) is often used to describe the pressure in the thoracic vena cava near the right atrium.

Purpose :

29 Purpose To assess the left ventricular end-diastolic pressure indirectly.
To evaluate the hemodynamic response to fluid therapy, medication and other treatments.
To obtain accurate central vascular pressures in the presence of low cardiac output.
To obtain mixed venous blood samples.
To measure cardiac output.

Slide 49:

49

Pulmonary Capillary Wedge Pressure (PCWP) :

50 Pulmonary Capillary Wedge Pressure (PCWP) Zero the transducer to the patient’s phlebostatic axis.
Measure the PCWP at end expiration
PCWP should not be higher than PA diastolic
PCWP is an indirect measurement of left ventricular end diastolic pressure.

Cardiac Output :

51 Cardiac Output It is the amount of blood pumped by the heart in one minute.
Calculated by multiplying heart rate times stroke volume.
Cardiac Index is the cardiac output adjusted for body surface area.

Noninvasive Hemodynamic Monitoring :

Blood Pressure :

55 Blood Pressure Manual
Oscillotonometry

Manual Blood Pressure :

56 Manual Blood Pressure Profile of Korotkoff sound

Manual Blood Pressure :

57 Manual Blood Pressure Korotkoff IV vs V sound
Korotkoff IV is a better indication of diastolic pressure according to theory
However Korotkoff V is the commonly recommended measuring point except in pregnant patients because
It is associated with less inter-observer variations
It is easier to detect by most observer

Blood Pressure - Oscillotonometry :

60 Blood Pressure - Oscillotonometry Interpretation
It was shown that the mean pressure obtained by oscillotonometry correlates best with other means of blood pressure monitoring
It is also the parameter that is most reproducible.

Slide 61:

61

Slide 62:

62 ‘To be conscious that you are ignorant is a great step towards knowledge.’
- Benjamin Disraeli